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Peebles I, Cronje JL, Clark L, Sharpe H, Duffy F. Experiences of inpatient eating disorder admissions: A systematic review and meta-synthesis. Eat Behav 2023; 50:101753. [PMID: 37329771 DOI: 10.1016/j.eatbeh.2023.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE There has been a significant increase in the number of inpatient admissions for individuals with eating disorders and, with the most critical cases requiring inpatient treatment, it is essential that we continue to improve associated outcomes. The aim of the study was to synthesise the available qualitative literature on the experiences of inpatient admissions for eating disorders to understand individuals' experiences and identify areas that may require further research and/or service development. METHOD Searches were performed on the following online databases: PsycINFO, PsycArticles, PsycTherapy MEDLINE, Embase, CINAHL, ASSIA, Scopus and Proquest Open Access Theses. Only papers with qualitative data regarding individuals' experiences of inpatient eating disorder treatment were considered. The CASP qualitative checklist was used to assess studies and relevant data items were extracted. Thematic synthesis was used to integrate the findings in the identified studies. GRADE-CERQual was used to rate the confidence in the findings. RESULTS Twenty-eight studies were identified which the CASP assessment considered to be adequate. The synthesis produced 5 main themes; 'Care and control', 'Inpatient bubble', 'Being supported and understood', 'Challenges of living with others' eating disorders' and finally 'Relationship to eating disorder'. The GRADE CERQual framework rated findings with high or moderate confidence. CONCLUSIONS Findings reaffirmed the importance of patient-centred care and the significant impact of being separated from normal life with others also experiencing an eating disorder.
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Affiliation(s)
- Imogen Peebles
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Jamie-Lee Cronje
- CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Lilli Clark
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Helen Sharpe
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Fiona Duffy
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
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Reid N, Buchman D, Brown R, Pedersen C, Kozloff N, Stergiopoulos V. The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1060-1071. [PMID: 36071341 DOI: 10.1007/s10488-022-01217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. METHODS As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. RESULTS Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. CONCLUSION Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, 155 College St, M5T 1P8, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 60 Leonard Ave, M5T 0S8, Toronto, ON, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada.
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Boerkoel A, Brommels M. The processes involved in the establishment of user-provider partnerships in severe psychiatric illnesses: a scoping review. BMC Psychiatry 2022; 22:660. [PMID: 36289473 PMCID: PMC9608879 DOI: 10.1186/s12888-022-04303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the rising relevance of person-centred care, initiatives towards user-led decision making and designing of care services have become more frequent. This designing of care services can be done in partnership, but it is unclear how. The aim of this scoping review was to identify for mental health services, what user-provider partnerships are, how they arise in practice and what can facilitate or hinder them. METHODS A scoping review was conducted to obtain a broad overview of user provider partnerships in severe mental illness. Data was inductively analysed using a conventional content analysis approach, in which meaning was found in the texts. RESULTS In total, 1559 titles were screened for the eligibility criteria and the resulting 22 papers found relevant were analysed using conventional content analysis. The identified papers had broad and differing concepts for user-provider partnerships. Papers considered shared decision making and user-involvement as partnerships. Mechanisms such as open communication, organisational top-down support and active participation supported partnerships, but professional identity, power imbalances and stress hindered them. Users can be impeded by their illness, but how to deal with these situations should be formalised through contracts. CONCLUSION The field of research around user-provider partnerships is scattered and lacks consensus on terminology. A power imbalance between a user and a provider is characteristic of partnerships in mental healthcare, which hinders the necessary relationship building allowing partnerships to arise. This power imbalance seems to be closely linked to professional identity, which was found to be difficult to change.
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Affiliation(s)
- Aletta Boerkoel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. .,Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
| | - Mats Brommels
- grid.465198.7Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
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Moyo N, Jones M, Kushemererwa D, Arefadib N, Jones A, Pantha S, Gray R. Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11001. [PMID: 36078717 PMCID: PMC9517907 DOI: 10.3390/ijerph191711001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Diana Kushemererwa
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Noushin Arefadib
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Adrian Jones
- Faculty of Life Sciences, Wrexham Glyndwr University, Wrexham LL11 2AW, UK
| | - Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
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Allerby K, Goulding A, Ali L, Waern M. Increasing person-centeredness in psychosis inpatient care: staff experiences from the Person-Centered Psychosis Care (PCPC) project. BMC Health Serv Res 2022; 22:596. [PMID: 35505358 PMCID: PMC9066767 DOI: 10.1186/s12913-022-08008-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background Interventions to increase person-centeredness in hospital care for persons with psychotic illness are needed. Changing care delivery is however a complex venture, requiring staff to reconsider their mindsets and ways of working. A multidisciplinary educational intervention for hospital staff at four wards was launched to increase person-centeredness in the care of patients with schizophrenia and similar psychoses. This study aims to explore staff experiences of working to increase person-centeredness. Methods A heterogenic sample of staff (n = 23) from all participating wards were recruited for six focus group interviews. Semi-structured questions covered staff perceptions of person-centered care and the process of increasing person-centeredness. Transcribed data was analyzed using thematic analysis according to Braun and Clarke. Results Staff viewed person-centered care as an approach rather than a method. They described central aspects of person-centered care, such as recognizing the patient as a capable person who can participate in her/his care. Statements further showed how these core features were put into practice. Changes related to the intervention were presented in terms of evolving patient and staff roles, improved contact with patients, more flexible care routines, and a more positive ward climate. Neither psychotic symptoms nor involuntary status were considered barriers for person-centered care, but organizational factors beyond staff control seemed to impact on implementation. Conclusions After implementation, participants displayed good understanding of the core concepts of person-centered care in both thinking and action. They attributed several improvements in the care milieu to an increased level of person-centeredness. Psychotic behavior and involuntary treatment did not present major barriers to person-centered care. Findings suggest person-centered care is feasible in the psychosis inpatient setting and could improve quality of care. Trial registration The study is part of a larger study evaluating the intervention Person-Centered Psychosis Care (PCPC). It was registered retrospectively at clinicaltrials.gov, identifier NCT03182283.
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Affiliation(s)
- K Allerby
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden. .,Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden. .,Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden.
| | - A Goulding
- Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - L Ali
- Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden.,Region Västra Götaland, Psychiatry Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - M Waern
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 15, 41345, Gothenburg, Sweden.,Region Västra Götaland, Psychosis Department, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.,Institute of Health Care Sciences, Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Box 100, 40530, Gothenburg, Sweden
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